The mental condition of a hospitalized patient can pose serious therapeutic challenges to medical care providers. Often, due to underlying medical conditions, the patient may exhibit serious and potentially life threatening psychological manifestations such as anxiety or delirium. Anxiety may be defined as a “state of intense apprehension or fear of real or imagined danger.” Delirium may be defined as a “state of marked confusion” that can be provoked by an underlying medical condition. Both anxiety and delirium can occur in hospitalized patients in an intensive care unit (ICU), progressive “step-down” medical floors, and general medical floors.
Many medical conditions can provoke significant anxiety. A pertinent example in the ICU setting is as follows: an elderly nursing home patient overdoses on pain medication, develops unconsciousness, and then aspirates food contents into the trachea and lung. The patient is emergently brought by emergency medical services (EMS) to the nearest emergency room (ER). This patient may require intubation and be placed on a mechanical ventilator (i.e., breathing machine) to facilitate breathing and oxygen/carbon dioxide exchange. During intubation, a tube is inserted through the vocal cords preventing the patient from speaking In addition, the patient is usually hand restrained to prevent accidentally pulling the life-sustaining tube out of her mouth. The above condition necessitates the patient to have a bed position that has the patient invariably looking up at a white-tiled ceiling or the like. In addition, ambient noise from other ICU patients' noise, ventilator/cardiac alarm noise, and conversation noise also contribute to a less than calming and peaceful “healing” environment. Many studies have shown that a typical ICU bed can have noise >75 db. This can lead to sleep deprivation over several days, which can result in altered conscious states and further anxiety and delirium.
Nursing and other medical staff personnel may make “bedside” attempts to reorient and calm a patient, but these good-intentioned efforts often do not lead to the desired result of a calm, cooperative, and oriented patient in the ICU or other hospital floors. Furthermore, these efforts are time-consuming, costly, and often ineffective due to staffing constraints and priorities. In addition, often there is a language barrier between the patient and the nurse/medical personnel potentially leading to significant more patient anxiety and confusion. The above factors can lead to a recurrent cycle of anxiety and delirium that is very difficult to break on a practical basis. As a consequence, nursing and medical staff personnel are unfortunately then necessitated to use intravenous (IV) anti-anxiety and anti-psychotic medications that have potential significant side effects. These side effects often include hypotension, lethal cardiac arrhythmias, electrolyte imbalance, and even further confusion paradoxically. In addition, several ICU peer-reviewed, evidence-based medical studies and clinical trials have demonstrated that unnecessary sedation medications lead to significant increased length of stay in the ICU, prolonged time on life support breathing machines, and significantly more costs in the thousands of dollars. Unfortunately, due to health care systems' limitations on nursing to patient staffing ratio and hospital financial constraints, constant “bedside” care to minimize anxiety or delirium risk factors have not been optimal.
If a patient improves in the ICU or other medical floor, the patient can potentially become more interactive with their environment and staff. At this point, the patient can be fully aware and cooperative with others. Unfortunately, many illnesses and just being in a hospital setting can lead to an anxious or even depressed mood. Often patients are spending countless hours waiting for tests to be done. Without connections to outside the hospital environment, patients can become bored, isolated, and detached.